What are the recommended vitamin A replacement doses for infants, children, non‑pregnant adults, and pregnant or lactating women with deficiency?

Vitamin A Deficiency Treatment

For vitamin A deficiency treatment, use 10,000–25,000 IU daily for 1–2 weeks in adults without corneal involvement, 200,000 IU every 3–6 months for children 1–5 years, 100,000 IU for infants under 12 months, and 200,000 IU postpartum for lactating women—with pregnant women limited to 10,000 IU daily maximum to avoid teratogenicity. 1

Treatment Dosing by Population

Infants (<12 months)

• Prophylactic supplementation: 100,000 IU every 3 months for the first year, or 200,000 IU every 6 months if 3-month dosing is impractical 2
• Treatment of established deficiency: 100,000 IU on day 1,100,000 IU on day 2, and 100,000 IU at 1–4 weeks (half the adult dose) 2
• Severe malnutrition or xerophthalmia: Same treatment schedule as above 2, 3

Children (1–5 years)

• Prophylactic supplementation: 200,000 IU every 3 months 2, 4
• Treatment of established deficiency: 200,000 IU on day 1,200,000 IU on day 2, and 200,000 IU at 1–4 weeks 2, 3
• Severe malnutrition, measles, or active xerophthalmia: Same high-dose treatment schedule 2, 4

Non-Pregnant Adults

• Mild to moderate deficiency without corneal involvement: 10,000–25,000 IU daily for 1–2 weeks until clinical improvement 1
• Deficiency with corneal involvement (medical emergency): 50,000–100,000 IU intramuscularly for 3 days, followed by 50,000 IU daily for 2 weeks 1
• Prophylactic dose for healthy adults: 6,000 IU daily, typically in a multivitamin 1
• High-risk adults (post-bariatric surgery): 10,000 IU daily to compensate for malabsorption 1

Pregnant Women

• Maximum safe dose: 10,000 IU daily to avoid teratogenic risk 1, 5, 6
• Preferred form: Beta-carotene rather than preformed retinol due to lower teratogenicity risk 1, 5
• Third trimester dosing (if postpartum dosing not feasible): 100,000 IU once during third trimester 2
• Assessment timing: Check vitamin A intake and blood levels before conception or early in pregnancy 2, 5

Lactating Women (Postpartum)

• Optimal timing: 200,000 IU within 2 months of delivery to provide adequate vitamin A in breast milk 2
• This single dose protects both mother and nursing infant 2, 4

Special Populations and Considerations

Cystic Fibrosis or Malabsorption Disorders

• Retinol (preformed vitamin A): Start low and adapt rapidly to target normal serum reference range based on monitoring 2
• Beta-carotene (provitamin A): 1 mg/kg/day (maximum 50 mg/day) for 12 weeks, followed by maintenance dose (maximum 10 mg/day) 2
• Monitoring: Check serum levels 3–6 months after initiation or dosage change, then annually 2
• Beta-carotene is safer than preformed retinol because it has negative feedback control and lower toxicity risk 2, 1

Refugee or Famine-Affected Populations

• Children 12 months to 5 years: 200,000 IU every 3 months 2
• Infants <12 months: 100,000 IU every 3 months, or 200,000 IU every 6 months if more frequent dosing is impractical 2
• Mothers: 200,000 IU within 2 months postpartum 2
• Older children and adults with xerophthalmia: Include in the standard 200,000 IU preventive program 2

Monitoring and Safety

Surveillance Schedule

• Annual monitoring of serum retinol levels once normal values are achieved 2, 1
• Check levels 3–6 months after any dosage change 2, 1
• Before pregnancy: Assess vitamin A intake and blood levels when pregnancy is considered 2, 5
• Do not assess serum retinol during acute infection, as inflammation lowers levels independent of true vitamin A status 2

Toxicity Thresholds

• Chronic toxicity: Occurs at doses above 25,000 IU daily for more than 6 years or above 100,000 IU daily for more than 6 months 1, 7
• Acute toxicity: Develops after >300,000 IU in adults or >60,000 IU in children within hours to days 7
• Safe upper limit for women of childbearing age: 10,000 IU daily 1, 7
• Water-miscible and water-soluble forms carry higher toxicity risk than oil-based supplements 2, 7

Critical Pitfalls to Avoid

Pregnancy-Related Errors

• Never exceed 10,000 IU daily in pregnant women or those of childbearing age due to teratogenic risk, especially in the first trimester 1, 5, 6
• Switch to beta-carotene form during preconception planning (3–6 months before attempting conception) 5
• Do not confuse preformed retinol with beta-carotene when calculating total vitamin A intake 1

Dosing Errors

• Always factor in dietary intake when prescribing supplements to avoid toxicity 1, 7
• Document all vitamin A doses on the child's growth record chart 2
• Recognize that serum retinol does not correlate well with tissue concentrations and may remain normal despite total-body overload 2, 7

High-Risk Populations Requiring Caution

• Chronic kidney disease (CKD): Vitamin A supplementation is contraindicated due to impaired renal clearance and accumulation risk 7
• Patients on retinoid medications (acitretin, isotretinoin): Avoid vitamin A supplements entirely and limit dietary intake to ≤2,400–3,000 IU daily 7
• Chronic alcohol use, diabetes, or obesity: Amplified toxicity risk when combined with systemic retinoids 7

Emergency Recognition

• Active corneal xerophthalmia is a medical emergency: Administer 200,000 IU immediately (100,000 IU for infants), repeat after 24 hours, then again at 1–4 weeks 2, 3, 4
• Corneal involvement requires immediate high-dose treatment to prevent irreversible blindness 2, 3